Designed to Fail: Why Foreign Aid Doesn’t Deliver

By Sakuntala Narasimhan

The World Health Organisation (WHO) notes in a publication released earlier this month that a “huge amount of new financial commitment, worth over $40 billion,” has been pledged by a collective of global agencies, towards maternal and child health projects in developing countries. The strategies that these projects will focus on include “innovative approaches” like the use of mobile phones “to create awareness and promote health” so that individuals and communities can have the information they need to make decisions about their health. Although the publication mentions the need to “address structural barriers to health,” the assumption is that lack of information and knowledge is the limiting factor. This assumption shows a woeful ignorance of the socio-cultural complexities that make up the local matrices within which “development” work has to be undertaken, which is why in spite of the hundreds of billions of dollars that have been poured into developing countries as aid in the last five decades, there has been no commensurate improvement in the social sector parameters in terms of adequate food, shelter, access to healthcare and education.

Poverty persists in the developing regions; the gap between the haves and the have-nots has in fact widened in the wake of globalisation over the last two decades. Despite substantial growth in GDP, those on the lower economic rungs in these nations (India, Bangladesh, Pakistan, and many countries of Africa and South America) have seen their lifestyle parameters worsen. Maternal mortality is still unacceptably high in these regions (the Asian subcontinent accounts for a quarter of global maternal deaths). Infants are dying in unacceptably large numbers, of illnesses that are preventable. So why haven’t the massive doses of aid from overseas succeeded in delivering what they set out to address?

A candid answer to that question can be found in a new publication, titled So Much Aid, So Little Development: Stories from Pakistan (Johns Hopkins University Press, ISBN 978-1-4214-0137-9) written by Samia Waheed Altaf, a Pakistani specialist in public health who was a member of an international team that oversaw the Social Action Programme (SAP) in Pakistan during the ‘90s. She has observed and chronicled the way decisions are made in disbursing aid from multilateral agencies. Using real life stories of aid recipients and beneficiaries, the book describes how giving and receiving aid has become an end in itself – the donor agencies have the satisfaction of putting on record that so many millions were spent on such-and-such projects, while the receiving country pats itself on its back on the inflow. Invariably, however, the American or European “experts” who fly in to devise, and advise on, health projects, have no idea of the local constraints, and come up with strategies that guarantee failure in terms of real improvements in ground realities.

Young girls are recruited for stipends, for instance, and given training in creating awareness on family planning or contraception. The girls enroll because they need the money, but once the training is over, there is no way their families are going to allow them to go from door to door “creating awareness” about contraception (or even about general health issues for that matter) because young women do not wander around like that, unaccompanied, to address strangers. Not done, certainly not in the rural Asian context. The “experts” who fly back with a report about the completion of the project, have no idea why the training doesn’t result in better community health indices. As for awareness, the lowliest among illiterate villagers knows of course, that it is inadvisable to drink polluted water – but what options do they have, when the factory set up (in the name of development) discharges toxic effluents into the river that is the source of water for the community? Or when water bodies dry up? Pregnant women do not deliver their babies at the hospital, not because they are ignorant but because they do not have the money to get to the nearest hospital, or there are no roads connecting the village to the city, or for a dozen other reasons. Women have multiple pregnancies not because they do not know any better, but because of son preference, which has nothing to do with foreign aid but decides how effective a project for limiting families will be. The western “consultant” who wonders why a woman does not walk out of a marriage where she is not permitted to go out and get involved in community work, is no different from the infamous French queen who wondered why the poor protesting about lack of bread could not eat cake.

The foreign experts stay at five star hotels, hire air-conditioned cars and go shopping for exotic handicrafts to take back as “bargain buys” (just $45 per cushion cover that would cost four times that much, in New York). Nearly 40 per cent of aid money goes back to the donor countries, as consultants’ fees (one of the conditions governing aid is that consultants from the donor country should be hired) and incidental expenses (hiring a fleet of vehicles, staff, field helpers, interpreters, meetings, daily or deputation allowances, publishing a glossy report with a liberal sprinkling of appropriate buzz words and highfalutin phrases).The human dimension gets completely ignored, in the pursuit of paper projections and academic analyses.

Samia Altaf gives you hilarious accounts of how advisors from overseas go about implementing their “projects.” The epilogue, where she voices her concern about the way the West “aids” the poorer countries with scant regard for the appropriateness of their strategies under local conditions, is alone worth its weight in gold. How many at the World Bank, IMF and WHO have read this account of how aid actually works? How many high level bureaucrats with policy making powers at these agencies, will make the effort, or learn from these observations?

Sakuntala Narasimhan is an award winning Indian journalist and author specialising in gender and development. This op-ed appeared in Dawn, Karachi, on October18, 2011 and is reproduced here with permission of the author.

A review by Jakob Steiner is here. Another in an academic journal appeared in Regional Studies 45:9, 1289-1290, 2011 by Claudia R. Williamson, Development Research Institute, New York University.

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8 Responses to “Designed to Fail: Why Foreign Aid Doesn’t Deliver”

Great write-up.
It may be noted that the overall life-expectancy in India as well as other countries of South Asia, has gone up over the past few decades, primarily because infant mortality has come down, thanks to advances in medicare, and this of course has led to a burgeoning population in the sub-continent too.

indiajones: In developed countries compared to those in South Asia, life expectancies are even higher and infant mortality even lower; yet the population is not burgeoning in those countries, indeed it is shrinking in many. The key variable is the birth rate and that has been declining globally; in many countries it is already below replacement level. The problem to worry about in India is undernourishment which afflicts almost half the children that survive. This would be a huge health burden to carry in the future quite apart from the loss in terms of productive potential.

The population explosion did not occur in Europe because they developed medicine over a long time. Initially birth rate was a steady high in both the places simply because one out of seven or eight child survived while death rate fluctuated wildly due to epidemics/ wars etc. The realization to cut birth rate because death rate had dramatically declined in Europe occurred simultaneously with advancement of medicine not so in South Asia where death rate declined overnight causing population explosion. Eventually it will reach an equilibrium..

Anil: This is a scenario that seems plausible but is not really factual. Death rates in Europe fell well before the development of medicine and were influenced primarily by better food supplies, investments in public health and improved hygiene from increased literacy. See the description of Stage 2 of the demographic transition in the following article: http://www.marathon.uwc.edu/geography/demotrans/demtran.htm

Sakuntala: Many foreign experts will react defensively to this book but that would be missing the point. It is difficult to make the case that the book does not suggest racial bias as a source of the problems. The real issue is the inequality of power and its unaccountability. It is just the reality that power today resides disproportionately in the West; in the case of aid it has to do with the source of the funding. And aid, because of the nature of its transmission chain, is particularly unaccountable.

Most people unthinkingly conflate superiority of power with the superiority of intelligence; some knowingly take advantage of it; some abuse it by engaging people with inappropriate skills; but there are many exceptions as well. This inequality of power has little to do with the color of the skin; we know how urban sophisticates relate to rural people in our own countries.

There is a post on the blog that describes a very moving example of such attitudinal biases in the West itself:

At bottom, I feel the combination of a number of things is at play: the generic nature of the expert-non-expert relationship, the inequality of power, the lack of accountability; the skewed incentives on both the donor and recipient sides; and project design that ignores human agency.

There is much to learn from cases where aid has indeed been been effective. One can pinpoint better the ingredients that are necessary for success. Channeling assistance in situations where the ingredients are missing is a disservice that compounds the very problems that are intended to be solved. There is some discussion of this in the following post on the blog:

“In America’s imperial theatre, Stewart and Mortenson exemplify a singular notion of “expert”. We can build, based on the profiles of other specimens – Robert D Kaplan, Fareed Zakaria, Robert Kagan – a picture of what the ideal type looks like from the official point of view. Such an “expert” is usually one who has not studied the region, and especially not in any academic capacity. As a result, they do not possess any significant knowledge of its languages, histories or cultures. They are often vetted by the market, having produced a bestselling book or secured a job as a journalist with a major newspaper. They are not necessarily tied to the “official” narratives or understandings, and can even be portrayed as being “a critic” of the official policy. In other words, this profile fits one who doesn’t know enough.“

The memorable chapters in the book are titled appropriately: ” The Pakistan Nursing Council: A Dead End”; The Women’ Division: A brief Encounter of the Worst Kind”; and “The Population Welfare Division: To be or Not to Be…”. The candid critique of how our institutions can be extremely useful if the policymakers and planners in Pakistan had the habit of reading or absorbing good advice. One can only hope that this book is widely read by multilaterals, bilateral agencies and most importantly the federal and provincial governments in Pakistan. I would strongly recommend an Urdu translation to facilitate the introduction of book at subnational levels of our policy machinery. Without pressure from below, the high-power wielders are not likely to think of reform.

Altaf has done a great job of weaving stories from Pakistan from all possible angles…. The next time an aid agency intends to invest in a Pakistan programme, it needs to read this book first. Otherwise, aid in the name of poor will keep on bypassing them.